Analysis of Risk Factors for a Poor Prognosis in Patients with Anti-<i>N</i>-Methyl-D-Aspartate Receptor Encephalitis and Construction of a Prognostic Composite Score

Mo, Yejia; Wang, Li; Zhu, Libo; Li, Feng; Yu, Gang; Luo, Yetao; Ni, Meng

doi:10.3988/jcn.2020.16.3.438

Cited by 20 publications

(16 citation statements)

References 33 publications

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“…Little information about prognosis of late‐onset anti‐NMDARE in China has been available in recent years and were inconsistent 8,16 . Our conclusion is in line with several previous studies 7,9,17,18 . The possible reason might be that body immunity and function declined with age, so that older individuals were more vulnerable to various age‐related complications.…”

Section: Discussionsupporting

confidence: 83%

The prognosis of late‐onset anti‐N‐methyl‐D‐aspartate receptor encephalitis in China

Sun

Ren

et al. 2021

Acta Neuro Scandinavica

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Objectives Early‐onset anti‐N‐methyl‐D‐aspartate receptor encephalitis (anti‐NMDARE) differs from late‐onset anti‐NMDARE regarding clinical characteristics. Until recently, research focusing on prognosis of elder adults has been scarce and showed inconsistent results. This study aims to evaluate the prognosis of late‐onset anti‐NMDARE in China. Materials & Methods One hundred and twelve adults diagnosed as anti‐NMDARE in four hospitals in China were reviewed retrospectively. Outcome data were assessed using modified Rankin Scale (mRS) score in short term (3 months after discharge) and long term (≥12 months after discharge). The relapse rate was also computed. Multivariable logistic regression was used to evaluate whether there are substantial differences in functional outcomes and recurrence rate across two groups. Results Of the 112 patients with anti‐NMDARE, 81 (72.3%) were early‐onset disease and 31 (27.7%) were late‐onset disease. Of these, all had short‐term follow‐up and 70 completed long‐term follow‐up. Late‐onset anti‐NMDARE group showed better short‐term (OR 2.70, 95% CI 1.09–6.71) and long‐term prognoses (OR 10.25, 95% CI 1.90–55.15). Recurrence rates were statistically different between the groups (OR 4.25, 95% CI 1.22–14.75). Conclusion The prognosis for anti‐NMDARE in China was poorer for older adults relative to younger adults. The relapse rates were higher in late‐onset group compared to early‐onset group.

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Section: Discussionsupporting

confidence: 83%

The prognosis of late‐onset anti‐N‐methyl‐D‐aspartate receptor encephalitis in China

Sun

Ren

et al. 2021

Acta Neuro Scandinavica

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“…Previous studies of prognostic risk factors of AE reported similar findings (28). Mo et al revealed that age, disturbance of consciousness, and ≥ 50% slow waves on EEG were independent risk factors of a poor AE prognosis(29). In addition, the proportion of abnormal brain MRI signals in the poor-prognosis group was significantly higher than that of the good-prognosis group, which was consistent with prior studies.…”

supporting

confidence: 70%

Characteristics and Prognosis of Autoimmune Encephalitis in the East of China: A Multi-Center Study

Qiao

Liu

et al. 2021

Front. Neurol.

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Objective: This study aimed to investigate epidemiological characteristics, clinical manifestations, and long-term outcomes of patients with autoimmune encephalitis (AE) in the east of China.Methods: From January 2015 to December 2019, 226 potential AE patients were recruited from five clinical centers, and a total of 185 patients who met the diagnostic criteria were included in the study. We retrospectively reviewed clinical features, auxiliary examinations, details of treatments, and outcomes of AE, and identified risk factors of poor prognosis. Modified Rankin Scale scores were used to evaluate neurological function, and scores of 3–6 indicated a poor-prognosis.Results: Patients with five main subtypes of AE were enrolled in the study, as follows: anti-NMDAR (79), anti-LGI1 (55), anti-CASPR2 (30), anti-GABABR (16), and anti-AMPAR (5). Among 185 patients, 58.38% (108/185) were male and 41.62% (77/185) were female. The median age at disease onset was 41 years (interquartile range, 17–62). The most common clinical manifestations of AE were seizures (146, 78.92%) and memory deficit (123, 66.49%). A total of 95 (51.35%) patients had abnormal brain magnetic resonance imaging results. Electroencephalographic findings were abnormal in 131 (70.81%) patients, and 168 (90.81%) and 26 (14.05%) patients were treated with first- and second-line immunotherapies, respectively. All surviving patients were followed-up for at least 1 year (range 12–36 months). Good clinical outcomes were achieved in 117 (63.24%), while 68 (36.76%) patients had a poor prognosis. Further, 33 (17.84%) patients relapsed and 10 (5.41%) died within 1 year post-discharge. Older patients tended to have a poorer prognosis, and the occurrence of mental behavioral disorders, movement disorders, disturbance of consciousness, central hypoventilation, and tumors were overrepresented in the poor-prognosis group.Conclusions: AE is a treatable disease, and most patients have a good prognosis. There are differences in the clinical manifestations of patients with different AE subtypes. Some with AE will relapse, and long-term follow-up is of great significance for further research.

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“…In our study, we also found that the increasing age was significantly associated with a poorer long-term prognosis of patients with AE. This conclusion is in line with several previous studies ( 23 – 25 ). However, no association was found between age and short-term first-line treatment response in this study.…”

Section: Discussionsupporting

confidence: 94%

Influential Factors, Treatment and Prognosis of Autoimmune Encephalitis Patients With Poor Response to Short-Term First-Line Treatment

Liu

Zhang

Huang³

et al. 2022

Front. Neurol.

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ObjectiveThis study was performed to assess the potential factors for poor short-term first-line treatment response, the appropriate further treatment options, and the prognosis in patients with autoimmune encephalitis (AE).MethodsThis retrospective study consisted of 135 patients with AE. According to their short-term first-line treatment response, patients were divided into the response group and the non-response group. The demographics, clinical characteristics, main accessory examinations, immunotherapy, and outcomes of patients were compared between the two groups. Univariate and multivariate logistic regression models were used to analyze whether non-responders have poor long-term outcomes. Further treatment and prognosis of non-responders were also analyzed.ResultsOf the 128 patients who were treated with first-line immunotherapy, 59 (46.1%) were non-responders. Patients in the non-response group had more symptoms and exhibited a higher proportion of mental behavior disorder, central hypoventilation, and autonomic nervous dysfunction. The modified Rankin scale (mRS) scores and neutrophil-to-lymphocyte ratio (NLR) levels were significantly higher and albumin, high-density lipoprotein cholesterol (HDL-C), apolipoprotein A (apoA) levels were significantly lower in the non-response group (p < 0.05, all). Multivariate logistic regression analysis showed that the number of clinical symptoms, mental behavior disorder, central hypoventilation, maximum mRS score, and albumin level was independently associated with non-response to short-term first-line treatment. Non-responders had poor long-term outcomes compared with the responders at all times of followed-up (p < 0.05, all). In multivariable analysis, initial first-line treatment response was independently associated with the long-term prognosis, both at 12-month [odds ratio (OR), 4.74, 95% CI, 1.44–15.59, and p=0.010] and 24-month follow-ups (OR, 8.81, 95% CI, 1.65–47.16; and p = 0.011). Among the non-responders, a higher improvement of mRS scores was observed in those who received second-line treatment than those who had no further treatment or repetition of first-line immunotherapy in the follow-up. However, the rate of a good outcome and median mRS scores were not significantly different among the three groups.ConclusionDisease severity, clinical features, anti-N-methyl-D-aspartate receptor subtypes, antibody titers, NLR, albumin, HDL-C, and apoA levels were all associated with non-response to short-term first-line treatment. The short-term first-line treatment response is a valuable predictor of long-term outcomes in patients with AE. Second-line immunotherapy may be a more aggressive treatment option for patients who failed short-term first-line immunotherapy.

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Analysis of Risk Factors for a Poor Prognosis in Patients with Anti-N-Methyl-D-Aspartate Receptor Encephalitis and Construction of a Prognostic Composite Score

Cited by 20 publications

References 33 publications

The prognosis of late‐onset anti‐N‐methyl‐D‐aspartate receptor encephalitis in China

The prognosis of late‐onset anti‐N‐methyl‐D‐aspartate receptor encephalitis in China

Characteristics and Prognosis of Autoimmune Encephalitis in the East of China: A Multi-Center Study

Influential Factors, Treatment and Prognosis of Autoimmune Encephalitis Patients With Poor Response to Short-Term First-Line Treatment

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